Swine Flu Doctor Danger?

A friend just called me; her 4-year old is sick. Rather than bringing her in, the doctor ordered a prescription for Tamiflu and said to give it to the entire family, including the the 10-month old. Then I found this. It’s from 2004; is Tamiflu now safe for infants under one year of age? Or is this an irresponsible doctor?

Signed,

Throwing Baby Out With Bathwater?

Hey Baby,

Okay, I’ve been there – I know how this doctor may be feeling – those moments (often at 3:27 am) when you can’t even finish one phone call before the beeping lets you know three more are rolling over to voicemail. While I’d like to acknowledge (and honor) the fact that we’re all human, there are (at least) two important issues for all of us in your question – 1) should doctors be “calling it in” when it comes to the swine flu scare, and 2) should infants be getting a medicine that’s neither licensed nor approved (nor, frankly, even tested) for their age group?

And, most importantly, what can we all do to improve the situation?

First – no, doctors probably shouldn’t be “calling it in.” Even harassed, exhausted, multi-tasking doctors. Why? There’s a great explanation from Dr. Jon La Pook, the Medical Correspondent for CBS News about the risks of dispensing Tamiflu willy-nilly. Basically – now follow along, it gets a bit slippery up ahead – we don’t have many (any?) other options as far as treatment goes if this virus does turn ugly (even this upcoming fall/winter), AND if we take it now when things are “mild” we’re breeding resistance (already estimated as high as 10% in prior H1N1 strains of influenza in this country), AND if we stockpile it, then, when we finally need it, it might be worthless, AND stockpiling Tamiflu can lead to very real shortages for the people who actually could be benefiting from it – which IN TURN leads to more virus droplets being coughed into our collective airspace, leading to (drumroll please) faster spreading, nastier virus. Which means that people who hoard, or unnecessarily take Tamiflu may actually make their risk of getting bad pandemic disease – worse! Did everyone follow that? – I got a touch of vertigo around step three, but that’s just me.

Bottom line? Influenza virus mutates so fast that, in comparison, bacteria seems carved in granite [for the visual learners among us – Influenza = Road Runner; bacteria = Wile E. Coyote, poised suspended in the air over a canyon]. Just look at the mess we’ve gotten ourselves into with resistant bacteria from overprescribing antibiotics right and left. Did we (docs) learn nothing, people?

Second, when a doc is tired, overworked, probably (like almost every single primary care provider in America) vastly underpaid, and is “calling it in” – that’s when mistakes get made. The study mentioned above is in animals and the doses used were astronomical.

Sure, giving doses of this drug to a 10-month old is “probably okay.” Unfortunately, the harsh fact is, even in a best-case situation, if you take a drug that’s been relatively untested, and give it to a lot of people, usually there are (eventually) some nasty surprises discovered. The fact that a new adverse event is “rare” is no consolation to the person who suffers from it. And certainly not to the parent of a baby.

Given the info here, I have no way of knowing if this doc’s decision was a thoughtful one based on a careful, thorough weighing of risks versus benefits – but my concern is that the doc may not even remember, or maybe forgot to even ask, if the babe is one year old yet.

Take Home Lesson For Us All – if you’re calling in symptoms of possible swine flu, we all should be helping prevent medication errors/mistakes – especially in times like these. Ask this important question – if I (my family) is sick enough to take Tamiflu, shouldn’t I (we) be tested for swine flu? And be sure to remind a family doctor of everyone’s ages, medical conditions, other medications and allergies, and if anyone might, by any conceivable (heh) chance be pregnant. Let’s not have prevention end up worse than the disease…

Got a thingie on your doohickey? Or are you pondering how to tell your doctor he’s a jerk? Send your burning healthcare questions to Doc Gurley by emailing docgurleyatgmaildotcom. Doc Gurley cannot answer every question, and she cannot practice medicine through a keyboard (not even with her stethoscope pressed firmly against the monitor) but she promises your questions will be kept strictly confidential.